POS0822 DOES CONCOMITANT/NON-CONCOMITANT USE OF MTX WITH BIOLOGICS AND JAK INHIBITORS AFFECT ULTRASOUND FINDING OF INTRA-ARTICULAR SYNOVITIS?
Authors: T. Okano, K. Mamoto, Y. Yamada, S. Anno, Y. Domae, A. Yagami, S. Washida, Y. Yoshida, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Biological disease-modifying antirheumatic drugs (bDMARDs) and janus kinase inhibitors (JAKi) are generally more effective combined with methotrexate (MTX) in patients with rheumatoid arthritis (RA). However, in clinical practice, bDMARDs/JAKi is sometimes used without MTX for such as elderly patients with poor renal function. To date, there are few reports evaluating ultrasound finding of intra-articular synovitis in patients with RA treated bDMARDs/JAKi with or without MTX. <h3>Objectives</h3> Ultrasound finding of intra-articular synovitis in patients with RA treated bDMARDs/JAKi with or without MTX was compared by using propensity score matching. <h3>Methods</h3> A total of 750 RA patients who underwent ultrasound examination were included. Ultrasond examination was performed at the of bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints. Of all 750 RA patients, 517 RA patients (68.9%) who treated bDMARDs/JAKi were divided into with or without MTX. Then, patients were matched using the propensity score adjusted for age, sex, duration of RA, disease activity (CDAI), CRP level, and MMP-3 level. The total gray scale (GS) and power Doppler (PD) score (GSUS/ PDUS) were compared between bDMARDs/JAKi treated patients without and with MTX. <h3>Results</h3> There were 159 (30.8%) patients without MTX and 358 (69.2%) patients with MTX. The 151 patients in each group were matched. The mean MTX dose of bDMARDs/JAKi with MTX group was 8.8±3.5 mg/week. Patients' characteristic of bDMARDs/JAKi without MTX and bDMARDs/JAKi with MTX were shown in Table 1. Ultrasound synovial findings were significantly suppressed in the MTX combined group, GSUS 11.6 ± 11.8 vs 8.5 ± 8.0 (p = 0.009) and PDUS 8.3 ± 9.9 vs 5.5 ± 6.2 (p = 0.004). Moreover, US findings were compared in TNF user, non-TNF user and JAKi user. Notably, ultrasound findings were worse in non-TNF inhibitor users without MTX. <h3>Conclusion</h3> Ultrasound synovial findings in patients with bDMARDs/JAKi was more suppressed with MTX. It was considered necessary to keep in mind that synovitis may persist in patients who are not concomitant with MTX and are using non-TNF inhibitors. <h3>Reference</h3> [1]Kaneko Y, Atsumi T, Tanaka Y, Inoo M, Kobayashi-Haraoka H, Amano K, Miyata M, Murakawa Y, Yasuoka H, Hirata S, Nagasawa H, Tanaka E, Miyasaka N, Yamanaka H, Yamamoto K, Takeuchi T. Comparison of adding tocilizumab to methotrexate with switching to tocilizumab in patients with rheumatoid arthritis with inadequate response to methotrexate: 52-week results from a prospective, randomised, controlled study (SURPRISE study). Ann Rheum Dis. 2016 Nov;75(11):1917-1923. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Tadashi Okano Speakers bureau: Abbvie, Chugai, Eli Lilly, Janssen and Novartis Pharma, Grant/research support from: Abbvie, Asahi Kasei, Chugai, Eisai, Eli Lilly and Tanabe Mitsubishi, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Shohei Anno: None declared, Yuka Domae: None declared, Asami Yagami: None declared, Shingo Washida: None declared, Yuko Yoshida: None declared, Tatsuya Koike: None declared, Hiroaki Nakamura: None declared.